Neonatal eruptions: benign or urgent?
A morphology and timing based approach to common newborn eruptions and dangerous mimics.
Updated: 2026-09-13
Written for clinicians and medical students
This section is a teaching reference for doctors, residents and medical students. It is not patient guidance and not a substitute for clinical examination, and it must not be used for self treatment.
Common benign patterns
- Erythema toxicum neonatorum usually begins after the first day with transient erythematous macules, papules and pustules while palms and soles are spared; the infant remains well [1].
- Transient neonatal pustular melanosis is present at birth; fragile pustules leave collarettes of scale and hyperpigmented macules, including on palms and soles [1].
- Milia are firm white keratin cysts, commonly on the face, and resolve without treatment. Neonatal acne has comedones, while neonatal cephalic pustulosis does not [1].
Red flags and first tests
- Fever, lethargy, poor feeding, respiratory distress, mucosal disease, grouped vesicles or rapidly progressive blistering require urgent neonatal assessment [2].
- Suspected herpes simplex requires prompt lesion PCR and blood or cerebrospinal fluid evaluation according to neonatal protocols; do not delay empiric antiviral treatment in an unwell infant [2].
- Consider bacterial culture, fungal microscopy, blood cultures and skin biopsy according to morphology. Maternal infection, medicines, consanguinity and family blistering history change the differential.